A型肉毒毒素治疗儿童痉挛型肌张力障碍的护理

局部肌内注射A型肉毒毒素治疗儿童痉挛型肌张力障碍是一种新的治疗方法。报道260例患儿接受A型肉毒毒素治疗前后的观察和护理。（1）治疗前对患儿关节活动度、肌张力进行评估，有针对性地做好心理护理，减少因心理紧张而导致的过度肌肉痉挛；注射前准备好抢救药品及物品，做好操作过程中的应急措施。（2）注射时根据解剖知识触摸动脉走向，避开大血管，注射过程中不断与患儿交谈，安抚患儿，注意观察患儿有无呼吸异常、突然停止哭闹、大汗、反应迟钝、不应答、面色苍白、四肢冰凉等不良反应。（3）注射后注意观察患儿的生命体征及药物不良反应，如咀嚼无力、吞咽困难、呼吸异常等；评估异常姿势、步态及关节活动度，进行康复训练指导；做好出院指导，告知家长及患儿在出院回家2-4周时为药物不良反应高峰期，可能出现注射肌群过度无力，要求家长注意观察患儿走路是否易摔跤，有无明显双腿发软、无力等情况。260例患儿经治疗后提高了关节活动范围，运动功能均得到不同程度的改善，有效率95％。所有患儿生命体征平稳，无吞咽困难、咀嚼无力、呼吸异常等现象。

Nursing of the Children with Spasm Dysmyotonia Treated with Type A Botulinus Toxin

Local injection of type A botulinus toxin is a novel therapy to treat child spasm dysmyotonia. The paper reports the observation and nursing of 260 children patients treated with spasm dysmyotonia. （1） Before treatment, joint activities and muscular tension should be evaluated; mental care should be conducted to prevent over spasm; emergency drugs should be prepared before injection and emergency precautions should be taken into account. （2） In injection, the great blood vessels should be kept away by feeling direction of arteries; during injection, the nurses should soothe them by keeping talking to the children; the adverse reactions should be observed closely including abnormity in respiration, sudden stopping of cries, over sweating, slowness in response, no response paleness in appearance and coldness in extremities. （3） After injection, their vital signs and the adverse reaction of the drug should be observed like mastieatory atonia, dysphagia and abnormity in respiration; the abnormal posture at walk and joint activity should be evaluated and rehabilitation training should be done to them; the families should be informed that crest-time is 2-4 weeks after discharge from hospital and the over-weakness is likely to occur in the injected muscles; nurses should warn the families to make sure if the children are easy to fall to the ground and there is visible weakness in the lower extremities. Through treatment, all of the children patients had improvements in joint activity and motion function, with an effectiveness of 95%. The vital signs all were stable, without masticatory atonia, dysphagia or abnormity in respiration.